By Robert Mann
It’s finally going to happen. Louisiana’s next governor will almost certainly expand the state’s Medicaid program under provisions of the Affordable Care Act. Unlike Gov. Bobby Jindal, state Rep. John Bel Edwards and U.S. Sen. David Vitter say they won’t reject the federal dollars to provide health insurance to the state’s working poor.
Until 2017, the federal government will pay 100 percent of the cost of expanding Medicaid for 200,000 Louisiana citizens. Then, the state’s share will be 5 percent and will gradually rise to a maximum of 10 percent.
That’s a bargain for Louisiana. And it will save lives among the state’s working poor – people who earn too little to obtain Medicaid coverage but not enough to qualify for the federal subsidies for health insurance under the ACA. With Jindal gone, whoever occupies the Governor’ Mansion in January will work to provide health care coverage to those individuals and their families.
The bad news, however, is that beyond their general willingness to accept the federal Medicaid funds, Edwards and Vitter differ widely on how they will manage the expansion.
Edwards is unequivocal. He says he will expand Medicaid on “day one” of his administration. “I will expand Medicaid because it’s the right thing to do,” Edwards has said. He has also correctly noted that Jindal’s refusal to expand Medicaid means that $3.2 billion in Louisiana’s federal taxes have gone to other states. “Why wouldn’t we expand it?” Edwards has asked. “We have been giving our tax dollars to other states too long.”
While Edward says he will accept the federal funds on day one, Vitter will not. Vitter has a time-consuming and more onerous plan – asking the Obama administration to approve a waiver allowing him to create a Medicaid program tailored for Louisiana.
Vitter says he wants Medicaid expansion “on Louisiana terms, certainly not Barack Obama terms,” whatever that means. And, in discussing Medicaid, Vitter goes one step further: “I want to reform Medicaid, not expand the present system.” What are those reforms? Vitter hasn’t said.
Vitter’s waiver proposal might be politically clever, but it is unworkable, especially if he wants to provide the working poor with health care coverage as quickly as possible.
It could take a year for the Obama administration to rule on a waiver proposal. And if the administration rejects Vitter’s plan – and it has rejected waivers from other states – Louisiana’s working poor could go without insurance another year or more. Simply put, seeking a waiver means Medicaid expansion probably won’t happen in the first year of a Vitter administration.
As for the specifics of his proposed waiver, Vitter is vague. He will only say that he wants a “work requirement.” That’s an odd condition for a program specifically designed to provide health insurance for people who are already working. Surely, Vitter understands that these individuals do not qualify for Medicaid today precisely because they have low-paying jobs.
Almost as disconcerting as Vitter’s position on Medicaid expansion is his party’s use of the program to attack Edwards as an ally of President Obama. For weeks, the Republican Governors Association’s (RGA) “Right Direction PAC” has aired TV spots in support of Vitter. In one spot, a female announcer says, “Edwards pushed to expand Obamacare in Louisiana, calling it ‘a moral imperative.’ . . . And like Obama, John Bel Edwards will raise taxes to pay for his Obama-size government.”
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